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Managing Hallucinations

Hallucinations are a common and often distressing symptom of dementia. Your Loved One (LO) may see, hear, smell, taste or feel things that aren't really there. These thing can range from people to animals to lights, even insects. Their experiences feel real to them and reactions to these hallucinations are varied. Some LOs feel comfort from "seeing" their deceased relatives, while others may feel distressed. 

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Hallucinations stem from brain changes that affect perception and interpretation of sensory input. Your LO isn't "making things up." As stated above, not all hallucinations are upsetting; some people may even enjoy or find them reassuring. The key for caregivers is to respond with empathy, validation, and calm rather than confrontation. Arguing about or denying their experiences may lead to further escalation of symptoms or emotions.

Step 1: Stay Calm and Validate Feelings

Never argue, reason, or try to convince the person that what they're seeing/hearing/feeling isn't real. This can heighten their anxiety and lead to paranoia. Instead, acknowledge their emotions gently: "I know this is so scary for you. I'm right here with you and I'll keep you safe." A soft touch, hand-holding, or reassuring words like "Don't worry. I'll protect you" often helps shift focus and reduce symptom intensity.

Step 2: Assess for Safety and Triggers First

Ensure your LOs environment is safe. Remove sharp objects or anything that could be grabbed in fear. Check for underling causes:

  • Poor lighting (especially at night)

  • Shadows

  • Reflections

  • Fatigue

  • Pain 

  • Infections

  • Dehydration

  • Hunger

  • Medication Side Effects

  • Overstimulation

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Bright, even lighting during the day and soft nightlights can minimize visual misinterpretations. Keep a record of episodies (what was seen/heard/felt, when, mood, recent events) to help identify a pattern

Step 3: Use Gentle Distraction and Rediretion

Shift attention without confrontation: Suggest moving to another room, going for a short walk, listening to favorite music, looking at photos or engaging in simple and familiar tasks (i.e., folding towels). If the hallucination seems pleasant, it may not need addressing unless it's disruptive. For frightening ones, offer comfort first, then redirect.

Step 4: Optimize the Environment

Create a calm, low-confusion space:

  • Ensure good consistent lighting

  • Avoiding harsh glares

  • Remove mirrors/reflective surfaces

  • Reduce clutter that could be misinterpreted

  • Maintain a predictable routine

 

Familiar objects, soothing sounds, and aromatherapy can be grounding. Overall, attempt to minimzie visual complexity.

Step 5: Seek Medical Input When Needed

Report frequent, distressing, or worsening hallucinations to your LO's doctor. They may perfom an examination or tests to exclude treatable causes (i.e., infection) or consider non-drug therapies first. In severe cases, medications can help. 

Step 6: Build Support and Introduce Others Gradually

Hallucinations can strain can primary caregiver. Enlist family and friends or a medical professional to help share care and isolation.
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Building a support community isn't just good for you, it's good for your LO too if the individuals are introduced slowly and gently. It gives your LO more varied social interaction, which is a positive for enhancing quality of life.

Step 7: Prioritize Your Own Well-Being

Managing hallucinations is emotionally taxing for caregivers. Remind yourself that it's the disease and nothing to take personally.

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As always, remember that self-care is necessary to maintain caregiver resilience and prevent burn out. It doesn't have to be fancy or elaborate. Put on a song YOU like or light a candle that you enjoy. All of these things add up and give us boosts throughout the day.

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